Nursing school requires mandatory clinical rotations to develop strong bedside manners. Nurses serve as the communication hub within the multidisciplinary team, spending the most time with patients at the bedside.
For Bachelor of Science in Nursing (BSN) and Advocate Degree of Nursing (ADN), students are often divided into groups to rotate through different specialties until the last semester, when they break away for one-on-one preceptorship with their assigned mentors. However, things are slightly different when pursuing a Master of Science in Nursing (MSN).
Students are often strongly encouraged to find their preceptors for clinical rotations. If they cannot do so, the school will find a placement, but it is not always guaranteed and might cause delays in their rotations. This often poses a challenge for many students but is significantly harder for minorities, as many of us do not have many connections from the medical field in general.
This was the situation for me. I came to the U.S. as a teenager without my parents. I have aunts and uncles who have lived here, but they do not work in the medical field, nor do I know anyone. I started from ground zero.
Before I started NP school, I was too intimidated to make connections or ask around the physicians/providers I worked with for possible rotations. I needed help finding a preceptor. To make it even more challenging, when I found someone who worked in a large teaching hospital, I was told that I could not do my rotations there because their nursing school was also looking for placement for their students, even when my potential preceptor offered to take me and another student from the school.
At last, I could shadow a group of hospitalists at a small local hospital through a friend of a friend. Then, I found another cardiology group locally and rotated with multiple members there. My rotation experience was quite limited.
With that in mind, after a few years into my job, I started taking on NP students as a preceptor to create a pathway and help out students like me. With my immigration and minority background, I believe that I can form a connection with the students with support and understanding of their struggles. I want them to succeed.
My most recent student was from the Philippines. She moved to the U.S. a few years ago and settled in Florida after traveling to other countries. She had been doing clinical rotations with hospitals locally. Then, for her very last semester, she wanted to gain experience in a larger healthcare system, so she asked the school to place her in my hospital and assign her to me.
During the clinical rotation, she was engaging, eager to learn, and always asked great questions. Ultimately, she was extremely thankful that I had taken her as a student. I was thrilled not only because I had a great student but also because I was able to help someone like me succeed.
For any nurse and nurse practitioners reading this article, I strongly encourage you to take on a mentorship/preceptorship role to make a difference in a student’s school experience and career and to help them succeed.
I recall my first clinical rotation as being one of the most exciting but stressful experiences as a student nurse. I was excited to finally apply the theories that we were taught in class to the ‘real world.’ However, I soon realized I was very unprepared. From the very early start times, extremely long days, and limited support from some faculty and peers as I ventured down this new path ultimately resulted in exhaustion and feeling unprepared. These feelings eventually affected my self-confidence more times than I care to admit. In addition to that, let’s not forget the culture of the units that I would be assigned to for weeks at a time. No one told us that the nurses would scatter when they saw students enter the ward and those that were forced to be with us made it known that they were not pleased with having us ‘tag along.’
Based on my personal experiences, I decided to put together a few key steps that I know would have been beneficial to me when I was a student nurse entering my clinical rotations and hopefully will be a benefit to you today.
Let’s begin…
1. Be Prepared.
If you’re able to get some basic information regarding your specific patient or the types of patients on that unit a night or two before your clinical day, take some time to do some research.
Look up the diagnosis and medications attributed to these patients.
Write this information down in a small notebook that you can keep in your pocket that is easily accessible for you to review.
2. Be Early.
It’s a good practice to start this habit now in preparation for the real work world. Treat clinicals like your job!
Arrive a minimum of 15 minutes early. Grab some coffee or tea and take this time to review your material. This will also give you a few minutes of alone time with your clinical instructor, which is always a plus.
3. Look the Part.
I know that ‘looking good’ is NOT on the list of priorities for someone who is sleep deprived and stressed. However, it’s necessary and will leave a positive lasting impression.
Always make sure you are dressed per your school’s policy. If scrubs are provided or purchased, make sure they are always neat and pressed. If you are like me (i.e., not a morning person), pick a day during the week to complete this small task and NOT the night before.
Carry a small personal hygiene bag with you always so that you can ‘freshen’ up midday. This will revitalize you, especially if your clinical days are long.
Most importantly, don’t forget your necessary equipment: pens, stethoscope, penlight, scissors, etc.
4. Be Professional.
ALWAYS address your patient by Mr. and Mrs./Ms. unless they say otherwise, especially with patients who are older than you are. This is not only professional but also respectful.
ALWAYS introduce yourself to your patient when you enter their room and let them know that you are a student nurse and will be a part of their care team for the day.
Most importantly, SMILE. Patients and staff will appreciate it.
5. Be an Active Participant.
It’s OKAY to say ‘I don’t know but I will find the answer for you.’
It’s important to ASK for help when needed. As we all know, there is no I in TEAM.
I encourage you to ASK questions and ANSWER questions. This shows that you are not only prepared but eager to learn.
Whenever possible, volunteer to observe as many procedures as possible. The more you can observe the better!
Aspiring advanced practice nurses enter their prospective graduate programs each semester with the good faith of excelling at their course work and practicum. Unfortunately, that notion may be tarnished by the misfortune of not finding a clinical site. In some instances, unwarranted cancellations by a preceptor occur. Leaving the pupil to hastily find another preceptor. Consequently, if the student is unable to obtain a new preceptor their graduation is postponed for months or sometimes years.
With the advent of online advanced nursing education, the demand for preceptors has skyrocketed. Many students spend months calling around for a preceptor to no avail. Plenty of primary care clinics are, booked full of students, a year or two in advance. To offset the demand some practices and health care practitioners have begun charging students for time spent precepting in their clinics. Thus, herein lies “an elephant in the room”: is it ethical for clinics to require payment for nursing practicums? Sadly, there is no straightforward answer to this question; yet among students there are two schools of thought.
One school of thought: “It’s unethical to pay for a clinical rotation. Why would I pay for something that a person should do out of the goodness of their heart?”
Central to any health profession is service. This act of unselfish kindness and generosity bears meaning to one’s career and, above all, sustain and dignify the future of others. In this instance, a pupil in need of mentoring isn’t too lowly for the time and attention necessitating growth. Unselfish service is marked by giving freely without expecting anything in return, as explained within an excerpt from the Hippocratic Oath, “To hold him who taught me this art equally dear to me as my parents, to be a partner in life with him, and to fulfill his needs when required; to look upon his offspring as equals to my own siblings, and to teach them this art, if they shall wish to learn it, without fee or contract…”
Second school of thought: “You’re paying for your education just as you would in a classroom environment.”
Some clinics are charging a minimum of $200 per week for a practicum experience. Which translates into $1,600 – $2,000 for an eight to ten week session. However, not all clinical sites are created equally. Some preceptors allow the pupils to independently see patients and afterwards they confer to execute a treatment plan for the individuals. Alternatively, other preceptors adopt a “hands off” approach and throw the student “out to the wolves” with little to no experience. How can schools of nursing solve this burgeoning problem?
Graduate nursing clinical rotations should be regulated by an accreditation body, such as the Commission on Collegiate Nursing Education (CCNE). Program effectiveness, assessment, and achievement of program outcomes are addressed within CCNE’s Standards for Accreditation. Presumptive regulation of graduate nursing clinical sites should be addressed under section IV – B, “program completion rates demonstrate program effectiveness”. How effective is the nursing program if students are not graduating due to sparse clinical sites? The school of nursing should be held accountable to help their students find practicum placement. If a large percentage of pupils are unable to complete the program of study due to insufficient assistance with securing a preceptor, a mandate should be place upon the school of nursing to provide a written explanation and analysis along with a plan of action for improvement before re-accreditation is approved for the graduate nursing program.
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